NIDDK-NCI Workshop on Pancreatitis-Diabetes-Pancreatic Cancer

Event Details

Background

The etiology of pancreatic ductal adenocarcinoma (PDAC) is poorly understood, and treatment is largely ineffectual because of the advanced stage of disease at presentation. The incidence of PDAC is increasing progressively, such that PDAC may become the leading cause of cancer-related deaths in the United States by 2050. Although much research is being conducted on the biology and elucidation of possible therapeutic targets for this disease, progress in the prevention and early detection of PDAC has been slow.

Risk factors for PDAC include family history, smoking, obesity, chronic pancreatitis (CP), and diabetes mellitus (DM). The recent increase in the prevalence of Type 2 DM (T2DM) is thought to be contributing to a parallel increase in the incidence of PDAC. About one-half of all PDAC patients have DM at the time of diagnosis (an additional 30-40% have impaired glucose tolerance), and roughly one-half of the DM associated with PDAC is new-onset, having developed within 3 years of the subsequent diagnosis of PDAC. This new-onset, tumor-related DM is thought to be secondary or Type 3c DM (T3cDM), according to the American Diabetes Association classification of etiologies of DM.

Cohort studies reveal that only 1-2 percent of new-onset adult DM patients will develop PDAC. Screening strategies that target new-onset DM patients for the detection of occult PDAC, therefore, have been infeasible and ineffective. The identification and discrimination of T3cDM from the more prevalent T2DM is an approach that may identify the high-risk group which could allow more successful detection and surveillance methods.

Epidemiologic data suggest that different anti-diabetic therapies have differing impacts on the risk of developing PDAC. Laboratory data confirm a beneficial role of metformin in reducing or preventing PDAC, and suggest that GLP-1 receptor agonists may increase the risk of PDAC.

In patients with CP complicated by DM, the risk of PDAC is increased more than 30-fold. Despite this increased risk, there are no guidelines for the surveillance of CP patients or for the treatment of their T3cDM, which may affect their risk of developing PDAC.

Meeting Objectives

The purpose of the workshop on Pancreatitis-Diabetes-Pancreatic Cancer is to explore the known and suspected mechanisms for the increased risk for PDAC associated with CP and DM, to identify the prevalence of T3cDM in the overall DM population and to assess strategies to discriminate T3cDM from T2DM, to review the effects of anti-diabetic therapy on the development of PDAC, and to explore possible PDAC surveillance methods for T2DM and T3cDM patients. Participants will develop a series of opportunities and priorities that could inform further research efforts sponsored by both NIDDK and NCI.